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video-on-demand applications require high bandwidth in only one direction. Human life may be at risk if control signals sent to medical monitoring or dosage equipment are corrupted or degraded, or if electronic medical records cannot be accessed in a timely fashion. Even when no lives are at stake, the extreme sensitivity of personal health information could complicate security considerations, and the provisions of health care at the point of need—whether in the hospital, home, or hotel room—could increase demand for provider and consumer access to Internet resources via a variety of media.

This chapter reviews current efforts to improve the capabilities of the Internet and evaluates them on the basis of the needs of the health sector outlined in Chapter 2. Particular attention is paid to the need for QOS, for security (including confidentiality of communications, system access controls, and network availability), and for broadband technologies to provide end users with high-speed connectivity to the Internet. Also discussed are privacy-enhancing technologies, which are seen by many as a prerequisite for more extensive use of the Internet by consumers. The chapter identifies ways in which the Internet's likely evolution will support health applications and ways in which it may not. It gives examples of challenges that real-world health applications can pose for networking research and information technology research more generally. In this way, it attempts to inform the networking research community about the challenges posed by health applications and to educate the health community about the ways in which ongoing efforts to develop and deploy Internet technologies may not satisfy all their needs.

Quality of Service

Quality of service is a requirement of many health-related applications of the Internet. Health organizations cannot rely on the Internet for critical functions unless they receive assurances that information will be delivered to its destination quickly and accurately. For example, care providers must be able to retrieve medical records easily and reliably when needed for patient care; providers and patients must be able to obtain sustained access to high-bandwidth services for remote consultations if video-based telemedicine is to become viable. In emergency care situations, both bandwidth and latency may be critical factors because providers may need rapid access to large medical records and images from disparate sources connected to the Internet. Other applications, such as Internet-based telephony and business teleconferencing, demand similar technical capabilities, but the failure to obtain needed QOS in a health application might put human life at risk.

Compounding the QOS challenge in health care is the variability of acontinue



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